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MINIMALLY INVASIVE RESECTION OF A SUBAORTIC MEMBRANE IN A CHILD VIA A VERTICAL RIGHT AXILLARY THORACOTOMY
Ali H. Mashadi, BA, Yasin Essa, MD, Sameh M. Said, MD.
Westchester Medical Center, Valhalla, NY, USA.
Objective(s): Demonstrating the technical aspects of resecting a subaortic membrane in a child via minimally invasive vertical right axillary thoracotomy (VRAT).
Methods: A 3-year old 14.6-kg child presented to our institution with severe left ventricular outflow tract obstruction. Transthoracic echocardiogram showed a discrete subaortic membrane 5-7 mm below the aortic valve. Decision was made to proceed with resection via a VRAT.
Results: A 5-cm vertical incision was made in line with the right midaxillary line extending from the 2nd to 5th ribs and the right chest was entered through the right third intercostal space. The right lung was retracted to expose the pericardial sac which was entered anterior to the right phrenic nerve. Cardiopulmonary bypass (CPB) was initiated via central aortic and bicaval cannulation. A hockey-stick aortotomy was made towards the middle of the non-coronary sinus of Valsalva and the membrane was completely resected with a limited septal myectomy. The aortotomy was then closed in a 2-layer fashion with 5/0 prolene suture. The heart was then de-aired and the aortic cross clamp (AXC) was removed. The AXC and CPB times were 37 and 58 minutes, respectively. The postoperative course was uneventful and he was discharged 48 hours later.
Conclusions: Discrete subaortic stenosis can be completely relieved in a minimally invasive fashion in children via a VRAT. This is associated with superb cosmetic results and short length of stay.
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